ABSTRACT

Hospital at Home (HaH) provides acute, hospital-level care at home and post-discharge follow-up. Through a review of 293 HaH admissions conducted by an urban, multidisciplinary HaH program from 2014 to 2017, we find that the social worker is involved in 71% of admissions and plays a crucial role in pre-emergency department discharge home care and safety screening, home intake, follow-up support, and transition of care to primary care providers and community-based services. We describe the social work activities involved in this model of care and present composite case studies for further illustration.

中文翻译：

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社会工作者在医院家庭护理服务团队中的独特作用

摘要

居家医院 (HaH) 提供急性、医院级的居家护理和出院后随访。通过对 2014 年至 2017 年城市、多学科 HaH 项目进行的 293 例 HaH 入院的回顾，我们发现社会工作者参与了 71% 的入院，并在急诊科出院前的家庭护理和安全筛查中发挥着至关重要的作用，家庭接收、后续支持以及向初级保健提供者和社区服务的过渡。我们描述了这种护理模式中涉及的社会工作活动，并提出了复合案例研究以供进一步说明。